History & Humanities

J R Coll Physicians Edinb 2018; 48: 181–91 | doi: 10.4997/JRCPE.2018.214 PAPER Witnessing history: a personal view of half a century in public health HistoryBP Bergman1, F Laing2, AS Chandler3, KC& Calman4 Humanities Former Chief Medical Of cer Sir Kenneth Calman recently celebrated 50 Correspondence to: years in medicine. It was a period which saw the evolution of the public BP Bergman Abstract health agenda from communicable diseases to diseases of lifestyle, the Institute of Health and change from a hospital-orientated health service to one dominated by Wellbeing community-based services, and the increasing recognition of inequalities as a Public Health & Health major determinant of health. This paper documents selected highlights from Policy his career including the Aberdeen typhoid outbreak, AIDS, bovine spongiform encephalopathy, 1 Lilybank Gardens foot and mouth disease, radioactive fallout, the invention of computerised tomography and Glasgow G12 8RZ magnetic resonance imaging, and draws parallels between the development of the modern UK understanding of public health and the theoretical background to the science 100 years earlier. Email: Keywords: communicable disease, communities, history, inequalities, public health beverly.bergman@glasgow. ac.uk Declaration of interests: No confl ict of interests declared Introduction an optimistic speech promising ‘a state of prosperity such as we have never had in my lifetime – nor indeed in the history of There is an iconic phrase which states that if you can this country…most of our people have never had it so good’. remember the Sixties, you were not there.1 An alternative, After the post-Great War austerity of the 1920s and 1930s but untested, hypothesis is that preservation of an intact that may have seemed true, but it was not to hold good for memory of this period may have been occasioned by the future. As early as 1961, Macmillan was forced to impose working in public health. Beginning in the 1960s, this spending cuts and a wage freeze as infl ation began to rise.3 paper examines fi ve decades of developments in public The Sixties had begun. health, focusing on some of the most infl uential events of the period, and was inspired by the 50th anniversary of Outbreaks, epidemics and pandemics had dominated public the graduation in medicine of one of the authors (KCC). It health practice during the 1950s – poliomyelitis, infl uenza, commemorates selected highlights from his career and, and even smallpox. Other serious communicable diseases in so doing, documents a key period of challenges and such as dysentery, infectious hepatitis and measles were transformations, predominantly from a Scottish perspective. so commonplace as to be accepted as a normal part of day It is illustrated by KCC’s personal refl ections. to day life. Although research published in 1950 had clearly demonstrated the link between smoking and lung cancer,4 Historical background the recognition of the importance of lifestyle choices as a determinant of health still lay many years in the future. The end of the Second World War saw Britain emerge The next 50 years were to bring many hitherto unforeseen militarily and politically victorious but at enormous cost to changes, both led by and requiring an agile response by population, economy and infrastructure. Nearly 400,000 public health. service personnel had lost their lives, together with over 65,000 civilians,2 two million homes had been destroyed The Sixties and much damage had been done to ports and industry. Food rationing, introduced in the wake of disruption to The Macmillan speech took no cognisance of the appalling supply lines, continued up until as late as 1954. Rebuilding poverty, overcrowding and living conditions that still of property was slow, and urban bomb sites persisted for characterised many inner cities where the bulk of the working many years as a visual reminder of the destruction, some population was concentrated. Slum clearance was already eventually mutating into car parks. under way, with the slums generally being replaced by high- rise blocks, but the 1961 census showed that 11,000 homes Nonetheless, the post-war global economy proved buoyant and in Glasgow remained unfi t for habitation (Figure 1).5 in 1957 the then Prime Minister, Harold Macmillan, delivered 1Honorary Senior Research Fellow, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; 2Curator of Offi cial Publications, National Library of Scotland, Edinburgh, UK; 3Doctoral student, 4Chancellor, University of Glasgow, Glasgow, UK JUNE 2018 VOLUME 48 ISSUE 2 JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH 181 BP Bergman, F Laing, AS Chandler et al. Figure 1 Mother and baby, Glasgow slums, late 1960s. ©Nick Hedges. Reproduced with permission to contaminated corned beef imported from South America, resulted in over 400 cases, but no fatalities. Although the timely public health response is acknowledged to have prevented a much larger outbreak,8 important lessons were learned, especially in relation to the provision of information to the public via the press. A well-intentioned campaign to alert the public to the importance of good personal hygiene, aimed at preventing a possible second wave of infection due to the development of asymptomatic carriers, led to a major over-reaction when places of entertainment were closed, academic staff at the University were advised to wear gloves when handling examination papers and the city became widely known as the ‘Beleaguered City’.9 However, clinical expertise developed at the University of Aberdeen in the aftermath of that outbreak still continues to inform the The spending cuts and wage freeze led to public disillusionment global management of this disease.10 and industrial unrest, and overall national income declined despite draconian measures aimed at boosting the economy. In 1960, a review of long-term National Assistance The failed US-led Bay of Pigs invasion of Cuba in 1961 was claimants was carried out; foreshadowing concerns about quickly followed by the 1962 Cuban missile crisis, while the number of benefi t claimants 50 years later. Only 6% ongoing nuclear tests in the Pacifi c underlined the continuing were found unfi t for any work although the majority had potential for global nuclear war. Rising levels of strontium-90 some limitation, including mental ill-health in 36% and in milk, as the fallout from the nuclear tests was deposited on gastrointestinal conditions in 12%. Many claimants were calcium-poor soils by Scotland’s high rainfall, led to concerns found employment, or were recommended for admission to about the future health of infants.6 Racial tensions were an industrial rehabilitation unit.11,12 building up worldwide, leading to widespread race riots in the USA in 1967. In the UK, immigration was increasing, The Seventies especially from Africa and the Indian subcontinent, and racial tensions were beginning to emerge here too, culminating in While the 1960s had been the decade of social change, the controversial and damaging speech by Enoch Powell in albeit not always benefi cial, and public health had been 1968. Social unrest grew widely, and was quickly adopted by focused largely on communicable disease and the growing the student population, resulting in mass protests throughout recognition of smoking-related disease, the 1970s were to the summer of 1968. As the decade drew to a close, tensions be dominated by far-reaching organisational reform in the within an increasingly divided Northern Ireland erupted into health services and local authorities. The National Health what was to become known as The Troubles. Service (Scotland) Act 1972 repealed and updated much of the original National Health Service (Scotland) Act 1947. It Against that background, societal norms were also changing. set up Health Boards, which remain the foundation of the Divorces rose steadily throughout the 1960s, even before structure of the NHS in Scotland, and established a number the legislative changes brought about by the Divorce Reform of central bodies including the Scottish Health Service Act 1969, leading to a rapid increase in the number of Planning Council and the Common Services Agency (now single parent families and, of necessity, working mothers NHS National Services Scotland), which greatly increased the and ‘latchkey kids’. The stress of coping unsupported by role of management in the NHS. The relationship between a spouse increasingly led to reliance on a new generation the Health Boards and local authorities was set out and, of psychotropic drugs, heavily promoted by industry as a while disestablishing the Medical Offi cer of Health, the Act panacea not only for patients7 but for a medical profession made provision for the appointment of a ‘designated medical facing new challenges from a rising tide of social problems. offi cer’ who would act on behalf of the local authority; this was to become a key role for public health. The post of Health Despite these evolving problems, by the beginning of the Service Commissioner for Scotland was established, to be 1960s, the fall in communicable disease rates since the appointed by The Queen. The Act also provided the legislative Second World War was becoming clear. In Scotland, for framework for the provision of contraceptive services and, example, diphtheria had already fallen from 517 cases in two years later in 1974, free family planning services were 1941 to 54 in 1960, but concerns were being expressed made available to everyone in Scotland, irrespective

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